Imagine going to the doctor’s office because you’ve had intermittent stomach pain that’s getting worse. You feel nauseous, you’re vomiting, and you know something is clearly wrong. The doctor wants to run some tests to find out more, but you don’t speak the same language she does.

You try to communicate as best you can, but when the test results come in and your doctor calls to have a conversation with you, you don’t understand what’s happening. That’s bad, because you have stomach cancer, and your doctor is trying to discuss treatment options with you.

If that sounds like a nightmare, it should. Unfortunately, for many people in the United States with limited English skills, it’s also a reality; doctors and patients can’t communicate across a language barrier. And while legal requirements stipulate that health care facilities need to provide translation services to patients, there’s ashortage of qualified interpretersthat’s compromising that ability.

People who can’t communicate clearly with their doctors may not be able to accurately describe symptoms they’re experiencing, or understand which tests are being ordered and why. They also can’t follow recommendations or understand prescription instructions — two things that could come with very dangerous consequences. If you don’t understand how many pills to take or when, or don’t heed a warning about avoiding something that could cause a medication reaction, you could become very ill.

Some patients are relying on family members as translators — a tough burden for children, spouses, siblings and parents. They themselves may not fully understand the issues at hand, garbling information provided by the doctor. And it’s a serious responsibility to be tasked with difficult conversations like explaining that someone has a terminal illness, or reviewing complex treatment options that may come with significant implications.

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Family members usually aren’t qualified medical interpreters. People in this profession have a very specific skill set: They don’t just know two or more languages. They’re also familiar with medical terminology, capable of both understanding and explaining complex concepts and checking in with patients to make sure the flow of communication is accurate. Their work is also extremely sensitive; they handle confidential medical information and need to comply with privacy laws, as well as ethics policies at the facilities they work with.

Some malpractice cases are linked to situations where patient and doctor were unable to communicate clearly, leading to tragic outcomes. Other patients may receive substandard care despite everyone’s best efforts, or unwittingly threaten public health because they aren’t complying with treatment recommendations.

The medical interpreter shortage isnot new. Officials have warned that health care facilities are unable to meet the needs of their patients for years, and this issue is only getting worse. With theAffordable Care Act, access to health insurance expanded radically across the United States, increasing the number of people able to seek medical treatment. This included many people with limited English skills who were finally able to get to the doctor’s office, but the doctor’s officewasn’t prepared to meet their needs.

There are tools at hand to enable better communication, including training and hiring more medical interpreters — though some facilities also rely heavily on volunteers. Promoting multilingual education for health care providers can also allow doctors to connect directly with their patients, building rapport and trust. Some facilities also rely on technology, such as interpreters available by phone who can serve a large number of facilities efficiently.

However, many of these services are in a state of flux because of ongoing policy confusion over health care and health care access. Worries about funding, access to insurance and other matters are making it challenging for health care facilities to create long-term plans, including establishing medical interpreter programs that accurately meet the needs of their patient populations. This is another example of how policy decisions can have unanticipated fallout.

s.e. smith is a writer, agitator and commentator based in Northern California, with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, class and the intersections thereof, with a special interest in rural subjects.

smith delights in amplifying the voices of those who are often silenced and challenging dominant ideas about justice, equality and liberation. International publication credits include work for the Sydney Morning Herald, the Guardian and AlterNet, among many other news outlets and magazines. Keep up with smith on Facebook. Follow smith on Twitter:@realsesmith.

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